Special Notice / Hearing: None__
Vote Required: Majority
To: Honorable Board of Supervisors
From: Louise F. Rogers, Chief, San Mateo County Health
Chester J. Kunnappilly, MD, Chief Executive Officer, San Mateo Medical Center
Subject: Agreement with University of the Pacific for its Arthur A. Dugoni School of Dentistry to Provide Dental Health Services at the Homeless Navigation Center
RECOMMENDATION:
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Adopt a resolution authorizing an agreement with University of Pacific for its Arthur A. Dugoni School of Dentistry to provide dental health services at the San Mateo County Navigation Center for the term of September 1, 2023, through June 30, 2028, for an amount not to exceed $300,000 per each year ending June 30th, and not to exceed $1,500,000.
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BACKGROUND:
The Navigation Center (Center) is a key component of the County’s plan to make interim or permanent housing available to every unsheltered person who chooses assistance. The Center provides 240 non-congregate units with intensive support services, including an on-site dental clinic. Oral health services are consistently identified as a needed service for people experiencing homelessness (PEH).
As the County’s federally supported homeless health program, the Health Care for the Homeless/Farmworker Health (HCH/FH) Program is a program of the San Mateo Medical Center (SMMC) with a mission to provide access to a full scope of ambulatory health services for PEH, including oral health services. Dental health services for the homeless are often a key component in their ability to re-engage in society, feel better about themselves, find employment and live better and fuller lives. However, paying for the cost of delivering this care is a perpetual challenge.
The Dugoni School of Dentistry is a nationally renowned dental education program, within the University of Pacific, located in San Francisco.
DISCUSSION:
This agreement will fund the delivery of dental health services to the homeless population at the San Mateo County Navigation Center and specialty dental health support to the San Mateo County Jail. The Contractor will provide a full range of preventive, diagnostic, and restorative dental services in accordance with Medi-Cal Dental (Denti-Cal) guidelines to an estimated 250 homeless residents each year who are housed at the Navigation Center, or inmates in the County's jails. Services may be provided by dental or dental hygiene students, residents, fellows, interns and/or faculty with general or specialty training.
University of the Pacific has estimated that the cost for providing the services is expected to be $600,000 per year, though at least $300,000 of that amount will be paid for through direct reimbursement from health insurance and coverage programs. Under this agreement, the Health Care for the Homeless/Farmworker Health Program will reimburse for any costs that are not paid for by health insurance and other health coverage programs, up to a maximum of $300,000 per year.
To fund this program, Healthcare for the Homeless/Farmworker Health has received several external grants, including Health Plan of San Mateo (1 year - $175,000), Kaiser Hospital (1 year - $75,000 possibly renewable), and the Sequoia Health Care District (5 year - $450,000), as well as support from the HCH/FH federal health center grant. In addition, the HCH/FH Program intends to develop additional support by requesting the Navigation Center be designated as a Federally Qualified Health Center site, which would allow it to benefit from enhanced Medi-Cal reimbursement rates.
SMMC is requesting the Board waive the request for proposals process for this agreement, in the best interests of the County. Waiving the RFP process is in the County’s best interests because the population served by the Navigation Center is unique. There are few dental providers with the capacity and wherewithal to address the population’s needs, and who are willing to accept MediCal (DentiCal) as payment. SMMC identified and solicited proposals from three providers that could potentially meet the criteria necessary to serve this population on the scale required. Of the three providers, only two submitted proposals. The proposals were reviewed by Senior Manager of Delivery System Planning Peter Shih and Dr. Mariam Hashoush, SMMC’s dental director. University of the Pacific provided the most comprehensive coverage at the best price. Further, County Administrative Memo B-1 exempts physician and urgent medical services from the requirement of a formal RFP. There is an immediate need to provide dental care to residents at the Navigation Center. This agreement is going to this Board late due to prolonged negotiations with the vendor.
The County Attorney’s Office has reviewed and approved the resolution and agreement as to form.
The resolution contains the County’s standard provisions allowing amendment of the County fiscal obligations by a maximum of $25,000 (in aggregate).
The County’s Contract Compliance Committee has approved a waiver request for a five-year term for this agreement.
It is anticipated that once fully operating, 250 individuals will receive oral health services each year.
PERFORMANCE MEASURE:
|
Measure |
FY 2023-24 Estimated |
FY 2024-25 Projected |
|
Number of individuals receiving oral health services |
250 |
250 |
FISCAL IMPACT:
The term of the Agreement is September 1, 2023, through June 30, 2028. The amount of the agreement is not to exceed $1,500,000 for the 58 months term. Funds in the amount of $350,000 are included in the SMMC FY 2023-24 Adopted Budget. Funds in the amount of $100,000 will be included in the SMMC FY 2024-25 Recommended Budget.
Expenses at SMMC are covered by fees for services or third-party payors whenever possible. The HCH/FH Program is committing grant revenue as necessary to support any shortfall in funding from direct service reimbursement or external grant awards, up to a maximum of $300,000 per year.